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SARS-CoV-2 proteins

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    No indications for overt innate immune suppression in critically ill COVID-19 MESHD patients

    Authors: Matthijs Kox; Tim Frenzel; Jeroen Schouten; Frank van de Veerdonk; Hans J.P.M. Koenen; Peter Pickkers; RCI-COVID-19 study group

    doi:10.1101/2020.04.03.20049080 Date: 2020-04-06 Source: medRxiv

    At the end of March 2020, there were in excess of 800.000 confirmed cases of coronavirus disease 2019 MESHD ( COVID-19 MESHD) worldwide. Several reports suggest that, in severe cases, COVID-19 MESHD may cause a hyperinflammatory 'cytokine storm'. However, unlike SARS-CoV infection MESHD, high levels of anti-inflammatory mediators have also been reported in COVID-19 MESHD patients. One study reported that 16% of COVID-19 MESHD patients who died developed secondary infection MESHD, which might indicate an immune-suppressed state. We explored kinetics of mHLA-DR expression, the most widely used marker of innate immune suppression in critically ill patients, in COVID- 19 patients admitted to the ICU. Twenty-four confirmed COVID-19 MESHD patients were included, of which 75% was male and 79% had comorbidities. All patients were mechanically ventilated and exhibited large high levels of inflammatory parameters such as CRP and PCT. Although mHLA-DR expression levels in COVID-19 MESHD patients were lower than those observed in healthy subjects, the extent of suppression was less pronounced than observed in bacterial septic shock MESHD patients. mHLA-DR expression kinetics revealed no change over time. None of the COVID-19 MESHD patients developed a secondary infection. In conclusion, despite a pronounced inflammatory response, mHLA-DR expression kinetics indicate more moderate innate immune suppression in COVID-19 MESHD patients compared with bacterial septic shock MESHD patients. These data signify that innate immune suppression as a negative feedback mechanism following PAMP HGNC-induced inflammation MESHD appears less pronounced in COVID-19 MESHD.

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MeSH Disease
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SARS-CoV-2 Proteins


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